I understand that I may participate in optional group therapy or counseling sessions as part of my membership with Sankofa Yoga & Wellness Center, LLC. I understand that the support of these sessions are not intended to be a substitute for clinical therapy. I understand that if I experience a crisis or am at risk of causing harm to myself or others, I must obtain emergency help and hereby agree to do so.

Upon my voluntary decision to participate, I agree to actively engage and respect the other group members and counselors. I further agree to uphold the confidentiality of this therapeutic setting. I agree to keep names and identities of other group members confidential.

I HEREBY ACKNOWLEDGE THAT THE COUNSELORS WHO PROVIDE CARE OR TREATMENT TO ME AT A SANKOFA HEALTH FACILITY OR ELSEWHERE ARE INDEPENDENT CONTRACTORS OF SANKOFA HEALTH, AND THUS ARE NOT EMPLOYEES OR AGENTS OF SANKOFA HEALTH.  I ALSO ACKNOWLEDGE THAT THE NATURE AND EXTENT OF SUPPORT SERVICES I RECEIVE ARE DECISIONS MADE BY THE COUNSELORS, AS INDEPENDENT CONTRACTORS, NOT BY, OR AT DIRECTION OF, SANKOFA HEALTH.  I FURTHER ACKNOWLEDGE AND AGREE THAT SANKOFA HEALTH HAS NOT MADE ANY REPRESENTATIONS TO SUGGEST THAT THE COUNSELORS FROM WHOM I RECEIVE SERVICES ARE EMPLOYEES OR AGENTS OF SANKOFA HEALTH, NOR AM I RELYING ON ANY SUCH BELIEF IN DECIDING TO SEEK SERVICES FROM COUNSELORS AT A SANKOFA HEALTH FACILITY. 

I HEREBY ACKNOWLEDGE AND AGREE THAT SANKOFA HEALTH IS NOT LIABLE FOR THE ACTIONS OR OMISSIONS OF, OR THE SUGGESTIONS GIVEN BY, THE COUNSELORS WHO SUPPORT ME WHILE I AM A CLIENT OF A SANKOFA HEALTH FACILITY. I AM ALSO AWARE THAT COUNSELOR SUPPORT SERVICES ARE NOT AN EXACT SCIENCE AND I ACKNOWLEDGE THAT NO GUARANTEES HAVE BEEN MADE TO ME AS TO THE RESULT OF THE SERVICES THAT I MAY RECEIVE AT A SANKOFA HEALTH FACILITY OR ELSEWHERE.